Chen David R, Cohen Philip L
Section of Rheumatology, Department of Medicine, Temple University School of Medicine, 3322 North Broad St., Room 205, Philadelphia, PA 19140, USA.
Int J Clin Rheumtol. 2012 Apr 1;7(2):159-166. doi: 10.2217/ijr.12.7.
The continued efficacy of B-cell depletion in rheumatoid arthritis (RA) depends on repeated cycles of anti-CD20 treatment to maintain low levels of B cells. It is surprising that this significant manipulation of the humoral immune system is remarkably safe with repeated treatment and that rates of adverse effects remain stable, and may even decline, over subsequent courses. Although responses to vaccines and probably to new antigens are diminished, adaptive immunity nevertheless functions adequately despite markedly restricted B-cell numbers. In the 10 years or so since the widespread use of B-cell depletion, there is little to suggest that a long-term paucity of B cells puts patients at risk for malignancy or opportunistic infections, nor that it leads to treatment-resistant RA or complications. While time will tell whether this major alteration of the immune system has other consequences, it is remarkable that drastic reduction of B-cell numbers over the long term is tolerated so well, and that it maintains efficacy in RA therapy.
在类风湿关节炎（RA）中，B细胞清除疗法的持续疗效依赖于反复进行抗CD20治疗循环，以维持低水平的B细胞。令人惊讶的是，对体液免疫系统的这种重大操控在反复治疗时非常安全，且不良反应发生率保持稳定，甚至在后续疗程中可能下降。尽管对疫苗以及可能对新抗原的反应减弱，但即便B细胞数量明显受限，适应性免疫仍能充分发挥功能。自广泛应用B细胞清除疗法约10年来，几乎没有迹象表明长期B细胞缺乏会使患者面临恶性肿瘤或机会性感染风险，也没有表明这会导致治疗抵抗性RA或并发症。虽然时间会证明这种免疫系统的重大改变是否有其他后果，但长期大幅减少B细胞数量能被如此良好地耐受，并在RA治疗中维持疗效，这一点很显著。
